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To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits.Retrospective chart review.The departments of Pediatrics, Adolescent Medicine, and Family Medicine of Cooper University Healthcare from January 1, 2010 to June 1, 2016.Women aged 12-21 years who were seen for a well visit in the described setting.None.We searched physician well visit notes for documentation of the following aspects of menstrual history: menarche, last menstrual period, usual length of cycle, and the presence or absence of associated symptoms (such as pain and cramps). The presence or absence of each aspect was recorded in a binary fashion in a deidentified data set.A total of 954 unique charts were analyzed: 415 from Adolescent Medicine, 289 from Family Medicine, and 250 from General Pediatrics at Cooper University Healthcare. Adolescent Medicine was 6.44 times more likely to take a complete menstrual history than Family Medicine (P .0001) and 5.80 times more likely than Pediatrics (P .0001). There was no statistical difference between Pediatrics and Family Medicine (odds ratio, 0.55; P = .3150).Menstrual history-taking is often incomplete and can vary between departments, even within the same institution. These results indicate opportunities to raise awareness about the importance of a complete menstrual history and to develop quality improvement initiatives to increase documentation of the complete menstrual history.

While doing a teen's preparticipation exam, the physician can go beyond sports-specific concerns to detect health problems in other areas. The examiner, whether through verbal queries or a questionnaire, can uncover concerns and risks for such common teen problems as drug use, sexually transmitted disease, and delayed development.

It is unclear why some adolescents experience substantial bone mineral density (BMD) loss, while others experience a minimal decrease during depot medroxyprogesterone acetate (DMPA) use. We examined biopsychosocial factors in adolescents who experienced ≥5% BMD loss from baseline compared with adolescents who experienced5% BMD loss during DMPA use.A multicenter, prospective, nonrandomized study of 181 female adolescents who initiated DMPA for contraception was conducted. BMD (by dual-energy X-ray absorptiometry) and serum estradiol were measured at initiation and every 6 months for 240 weeks of DMPA use.Half of participants experienced BMD loss of ≥5% from baseline at the hip, and a quarter experienced BMD loss of ≥5% at the lumbar spine (BMD substantial losers, SL). Hip and lumbar spine BMD-SL received a significantly greater number of DMPA injections than non-SL (p.001). Decreased estradiol levels did not statistically differ between BMD loss subgroups. Hip BMD-SL had significantly lower baseline body mass index (BMI) than non-SL (p=.002), and there was an inverse relationship between weight gain and degree of BMD loss. Mean calcium intake was significantly lower (p.05) in hip BMD-SL, and reported alcohol use was significantly higher (p.05) in lumbar spine BMD-SL compared with non-SL.BMD loss of ≥5% was more common at the hip than at the lumbar spine among adolescents using DMPA. Decreased serum estradiol levels did not correlate with magnitude of BMD loss. Lower BMI and calcium intake and greater alcohol use were associated with greater BMD loss in adolescents using DMPA.

Background This analysis was conducted to assess the baseline data and design methodology within an observational longitudinal comparison of use vs. nonuse of the injectable (intramuscular) contraceptive depot medroxyprogesterone acetate (DMPA-IM) and its effect on bone mass in adolescent women. Study Design A prospective, observational, open-label, unmatched-cohort, safety study in females aged 11–18 years. Participants either self-selected DMPA-IM (Depo-Provera®) 150 mg to be administered every 12 weeks for up to 240 weeks with a 120-week post-treatment follow-up or were nonusers (users of nonhormonal contraception or sexually abstinent) who were to be followed up for up to 360 weeks. As each participant entered the study, bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine, hip and femoral neck regions, along with total body bone mineral content; serum and urine specimens were obtained for assay of bone metabolism markers and participants' histories of parity and tobacco and alcohol use were obtained. Results A total of 389 participants were enrolled: 169 elected to begin DMPA-IM; 26 chose nonhormonal methods and 194 were abstinent. The baseline characteristics indicated significant disparities between DMPA-IM users and nonusers: compared with the nonusers, DMPA-IM users had more advanced chronologic and gynecologic ages, were more likely to have smoked, been pregnant and included more blacks. These factors would likely influence bone accretion rates independent of DMPA-IM exposure. Comparison of participant BMDs with standard reference data revealed that the study cohorts did not match reference populations closely enough to make a direct between-cohort comparative analysis feasible. Conclusions The baseline differences in cohort characteristics preclude a meaningful comparison of mean BMD changes over time between DMPA-IM users and nonusers cohorts, and comparisons of changes in Z-scores between cohorts were also not appropriate. Therefore, within-participant BMD decreases from baseline were established as safety thresholds, and the proportion of individuals crossing those thresholds on a persistent or progressive basis was identified as the revised primary end point.

Developmental disorders originate in infancy or early childhood, are associated with presumed or observed organic abnormalities, and have serious long-term physical and/or psychological sequelae. Of particular interest here are two such disorders, mental retardation and autism. Purported causes range from genetics, early prenatal and/or postnatal exposure to toxins (including heavy metals), and recently, vaccinations. Single factors have often been claimed to be the cause of a developmental disorder, without regard to possible exacerbating or alleviating roles of other factors, including socioeconomic status. Unfortunately, professional and popular literature on both claimed causes and effective treatments has often been characterized by research and theorizing that is seriously flawed (bad science) or actively misrepresented (pseudoscience). The present paper critically reviews selected research on a few controversial issues concerning developmental disorders, particular mental retardation and autism, and emphasizes the role of low socioeconomic status.

Adolescence is the period of life in which issues of sexuality come to the fore. This article describes the concept of sexuality, teens' expression of sexuality, and various consequences of sexual behaviors. Issues of sexual preference and identity are described,and a brief discussion of sex education is presented. Primary care clinicians should use this article as a basis for further exploration of these important issues for their adolescent patients.

Abdominal and pelvic pain are among the most common reasons adolescent women present to primary care physicians gynecologists and emergency departments. Caring for patients with unexplained chronic or recurrent abdominal symptoms can be both frustrating and time consuming. Both organic and psychosocial factors must be considered and both may simultaneously contribute to an adolescent’s experience of pain. An approach that explores concurrently the physiological and psychological components of pain is therefore a clinician’s most effective strategy. Although definitions vary chronic abdominal pain may be considered any pain that has been present continuously or intermittently for at least 3 months. Recurrent or intermittent pain may either be cyclic or noncyclic in nature. Pain with a specific identifiable physiological cause is often referred to as “organic” pain; pain without a clear identifiable cause and/or pain that appears to be exacerbated by psychosocial factors is frequently referred to as “functional” pain. (excerpt)

Much is written of adolescents taking risks, including using drugs and alcohol, without a clear understanding of factors that promote or deter such behaviors. This article attempts to clarify these factors in order to help physicians understand why adolescents behave in these ways and to help physicians develop methods to prevent these risky behaviors.